Nurse-administered propofol sedation for upper endoscopic ultrasonography

Hala Fatima, John DeWitt, Julia Leblanc, Stuart Sherman, Kathleen McGreevy, Thomas Imperiale

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background:Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy.AIMS: To evaluate the frequency of and the risk factors for complications associated with NAPS for upper endoscopic ultrasound (EUS).Methods: Consecutive upper EUS examinations using NAPS were retrospectively identified. Clinical data and adverse events were recorded. Univariate and multivariable repeated measures logistic regression models were used to identify independent risk factors for complications.Results: Among 806 EUS procedures, the mean procedure duration, time for sedation induction, and postprocedure recovery time were: 34 ± 20 min, 3.6 ± 1.4 min, and 27 ± 23 min, respectively. A decline in systolic blood pressure (SBP) to <90 mm Hg occurred in 104 patients (13%). Six patients (0.7%) had a decline in oxygen saturation (SpO"2) to <90%. Four patients (0.5%; 95% confidence interval [CI] 0.14-1.27) required assisted positive pressure ventilation. There were no major complications. The minor complication rate from sedation was 21% (95% CI 17.2-25.3). All of the complications were clinically insignificant. Overall complication risk was not related to age, dose, or procedure time. Sedation-related complication rates for advanced experience-level (≥100 NAPS procedures) nurses were lower compared to the least-experienced (≤30 NAPS procedures) nurses (17.2% vs 25.4%, odds ratio [OR] 0.61, 95% CI 0.41-0.92).Conclusions: NAPS for upper EUS is safe and may be performed without major complications. Four patients (0.5%) required assisted ventilation. Minor complications occurred in 21% of patients, but were not associated with patient age, propofol dose, or procedure time.

Original languageEnglish
Pages (from-to)1649-1656
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume103
Issue number7
DOIs
StatePublished - Jul 2008

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Endosonography
Propofol
Nurses
Confidence Intervals
Logistic Models
Blood Pressure
Positive-Pressure Respiration
Endoscopy
Ventilation
Odds Ratio
Oxygen
Safety

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

Cite this

Nurse-administered propofol sedation for upper endoscopic ultrasonography. / Fatima, Hala; DeWitt, John; Leblanc, Julia; Sherman, Stuart; McGreevy, Kathleen; Imperiale, Thomas.

In: American Journal of Gastroenterology, Vol. 103, No. 7, 07.2008, p. 1649-1656.

Research output: Contribution to journalArticle

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N2 - Background:Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy.AIMS: To evaluate the frequency of and the risk factors for complications associated with NAPS for upper endoscopic ultrasound (EUS).Methods: Consecutive upper EUS examinations using NAPS were retrospectively identified. Clinical data and adverse events were recorded. Univariate and multivariable repeated measures logistic regression models were used to identify independent risk factors for complications.Results: Among 806 EUS procedures, the mean procedure duration, time for sedation induction, and postprocedure recovery time were: 34 ± 20 min, 3.6 ± 1.4 min, and 27 ± 23 min, respectively. A decline in systolic blood pressure (SBP) to <90 mm Hg occurred in 104 patients (13%). Six patients (0.7%) had a decline in oxygen saturation (SpO"2) to <90%. Four patients (0.5%; 95% confidence interval [CI] 0.14-1.27) required assisted positive pressure ventilation. There were no major complications. The minor complication rate from sedation was 21% (95% CI 17.2-25.3). All of the complications were clinically insignificant. Overall complication risk was not related to age, dose, or procedure time. Sedation-related complication rates for advanced experience-level (≥100 NAPS procedures) nurses were lower compared to the least-experienced (≤30 NAPS procedures) nurses (17.2% vs 25.4%, odds ratio [OR] 0.61, 95% CI 0.41-0.92).Conclusions: NAPS for upper EUS is safe and may be performed without major complications. Four patients (0.5%) required assisted ventilation. Minor complications occurred in 21% of patients, but were not associated with patient age, propofol dose, or procedure time.

AB - Background:Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy.AIMS: To evaluate the frequency of and the risk factors for complications associated with NAPS for upper endoscopic ultrasound (EUS).Methods: Consecutive upper EUS examinations using NAPS were retrospectively identified. Clinical data and adverse events were recorded. Univariate and multivariable repeated measures logistic regression models were used to identify independent risk factors for complications.Results: Among 806 EUS procedures, the mean procedure duration, time for sedation induction, and postprocedure recovery time were: 34 ± 20 min, 3.6 ± 1.4 min, and 27 ± 23 min, respectively. A decline in systolic blood pressure (SBP) to <90 mm Hg occurred in 104 patients (13%). Six patients (0.7%) had a decline in oxygen saturation (SpO"2) to <90%. Four patients (0.5%; 95% confidence interval [CI] 0.14-1.27) required assisted positive pressure ventilation. There were no major complications. The minor complication rate from sedation was 21% (95% CI 17.2-25.3). All of the complications were clinically insignificant. Overall complication risk was not related to age, dose, or procedure time. Sedation-related complication rates for advanced experience-level (≥100 NAPS procedures) nurses were lower compared to the least-experienced (≤30 NAPS procedures) nurses (17.2% vs 25.4%, odds ratio [OR] 0.61, 95% CI 0.41-0.92).Conclusions: NAPS for upper EUS is safe and may be performed without major complications. Four patients (0.5%) required assisted ventilation. Minor complications occurred in 21% of patients, but were not associated with patient age, propofol dose, or procedure time.

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